Goodbye Taipei for now

The following Monday we went to consult Dr. Lee again. As DH did not want me to have another simulated/medicated cycle, so we had decided on doing a natural cycle FET. We told the doctor that we will do a natural cycle FET however not after a month's rest. We will do it most likely next year as we had to go back to Toronto at the moment. He gave us another follicle monitoring sheet and asked us to return to do the ultrasound before consulting him when we were back in Taipei. I will be almost 36 years old next year. Hopefully, we have made the right decision.

Day 27 (9DPT) - Beta HCG blood test and consultation with Dr. Lee

We woke up early and arrived at the hospital at 7:10 am. After we arrived, we went to the blood test clinic on the 1F and used one of the machines to scan the barcode on the appointment slip. The machine assigned us a number and when it was my turn, I went to the counter to have my blood drawn. My heart was pretty heavy at this point as I was still spotting. We were done by 7:30 am. We then went and had breakfast at the nearby Starbucks. DH comforted me by saying that even if the blood test is a BFN, it is okay as it is illogical to fret over something we never had in the first place. He also said that all that mattered was "at least we tried". I was rather calm having come to terms with the fact that it may be a BFN. We went back to the clinic at 9:30 am. When it was my turn to see Dr. Lee, I was called and I noticed my bHCG result on the computer screen. It was a mere 4.8 miu/ml. Dr. Lee advised us of the bHCG test result and told us that it means I wasn't pregnant. To my surprise, I took it pretty well. No tears and not getting emotional at all. My voice was normal and steady. He then asked us when we will like to do an FET. He said he could do a DET as well however will still advise us against it and to have an SET instead. As mentioned earlier in my blog, Dr. Lee has a conservative approach. He advised us the risks of having twins in case both blastocysts implants and asked us to have patience in the IVF process. We have the patience just not the time to stay in Taipei for so long. We asked Dr. Lee to give us the weekend to think over things a bit and we will return for consultation the following Monday. Also I asked him if the FET will work as the remaining blasts were of a lower grade than the 4AA that was transferred this time. He smiled and said that grades are assigned by the embryologist however it doesn't mean that a grade BB blast will be unsuccessful . After that we left the hospital and went to have Teppanyaki :) I did shed some tears later that day but DH and everyone else was pretty supportive. It didn't matter anymore if it didn't work this time around. It doesn't mean the next time won't work!! Just as DH said we did our best and if it didn't work, it may not be our turn yet to be parents. This is not the end, it is just the beginning! =) All is not lost. I made a mental note to be extra good to myself cause I know that in this world, no one can care more about me than myself!

Day 26 (8DPT) - HPT and Surprise!

On day 26, we decided to take an Home pregnancy test in the morning. I used Clear Blue Digital Pregnancy Test. As I was waiting for the result, I wiped and discovered fresh red blood on the tissue! What a bad surprise! So I wasn't too optimistic then and it was no surprise that the test showed "not pregnant". I was very heart broken. During the day I continued to spot with small clots (Sorry for the TMI) however by night it was a lot less. I still continued with the Crinone inserts as the next day was the blood test. I know that if the spotting stops, there is still hope however if it doesn't, then that means I am definitely not pregnant. DH asked me to remain optimistic however it was really hard for me as I myself know my body best.

Day 23 (5DPT) - Anything that goes up must come down

Yay!! Finally recovered from the flu today though I felt a lot better yesterday. The days immediately following ET was a nightmare. I can stand a cold just not a sore throat. So it's true that anything that goes up must come down sooner or later. Just when you think you can't bear it anymore, it starts becoming better!! =)

I spent the few days after ET resting in bed because of the flu and not because I wanted to be particularly careful. Today is 5DPT (days past transfer) and I have another 3 days to go before the much awaited blood test at 9DPT. I have no symptoms so far except for breast tenderness which I was experiencing even before egg retrieval so no biggie there. The daily homework is just vaginal application of Crinone twice a day and that's it. The instruction was to apply once in the morning when I get up and once at night (no set time indicated). I try to apply at the same time both in the morning and at night so the time gap between each application is 12 hours. My logical reasoning is that this ensures a constant supply of progesterone in the blood stream everyday. The same reasoning was applied to the follicle stimulating injections which I took at approximately the same time everyday - constant flow of hormones in the body. The doctor's assistant instructed to "try" to take the injections at the same time everyday however if it's not at the same time then it's okay too and I have read somewhere that the stims do not have to be at the same time everyday as well. However, I don't want my body to feel like it's on a roller coaster ride everyday - a huge dip and then a big surge in hormones. It's just my personal approach to taking medications - whether it is for IVF or for a UTI. I also try to lie down for 15-20 mins after Crinone application and then move around to optimize absorption of the hormone.

The last few days, while I was resting I couldn't help compare the equipment at IVF Canada and Mackay Memorial Hospital. At IVF Canada, when I underwent IUI, my feet were mounted on metal stirrups hanging from an upright pole like a pendulum. When the speculum was inserted, it was the most uncomfortable experience!! I think the speculum was not the right size? I could feel the entire thing going inside, it was next to painful!! I still flinch when I think of it! At Mackay Memorial Hospital, the embryo transfer  included inserting a speculum however I felt the least discomfort! It was very smooth almost like glided in. There are no stirrups but actual "legrests" (think of armrests? these are legrests!) on the sides, support for the entire leg, very comfortable! I would chose to come back to Mackay Memorial Hospital to do IVF again or if this cycle is negative, they have excellent facilities and most importantly, a great IVF team here. IVF Canada - BUH BYE FOREVER!! Note: I am not promoting Mackay Memorial Hospital. I am just writing an honest, unbiased experience at both IVF clinics. The operation bed has the same leg rests set up at Mackay Memorial Hospital.


~~~~Let the next 3 days roll~~~~~

Day 19 & 20 - Suffering

Holy smokes, my sore throat is getting worse. My nose is runny and I have a cough as well. My good lord, will my embryo survive in my weakened body? In my mind, I am trying to keep optimistic. I frantically searched on Google and looks like a cough and cold will not affect implantation. But I feel really bad today. I wish the pain in my tonsils were gone. I can't even take any antibiotics. Will I survive?? Will my embie survive??

Day 18 - Embryo Transfer

The 5-day embryo transfer was scheduled for 10:00 a.m. We arrived on time and was asked to wait in the waiting room. After about 20 minutes my name was called and Dr. Lee with an embryologist appeared and let us know the below grades of the embryos. We also signed paperwork to freeze the remaining 6 embryos. For information on embryo grading, please refer to the following link: http://www.advancedfertility.com/blastocystimages.htm

1 x 4AA
1 x 4BB
2 x 4CC
1 x 3BB
2 x EB (Early blastocyst)

Dr. Lee will be transferring one grade 4AA blastocyst to me. I was then led to the ET room. My husband was asked to stay behind. The ET process was painless, fast and smooth. I did feel some mild cramps during the process but that was it. I wasn't required to have a full bladder either. Dr. Lee doesn't provide a photo of the embryo as well as they think the embryos are sensitive to light and doesn't want to take the risk. When Dr. Lee was ready, the embryologist brought the embryo from the sliding door that I believe led to the lab and they timed the transfer. It was 15 seconds. I believe the maximum time allowed was 90 seconds. As I was coming down with a cold and sore throat, I asked if that would affect the implantation. I was told it will not affect however to not take any medications and drink lots of water and let the body heal on its own. After the transfer my husband was called to my side. I laid there for around 30 minutes before leaving. The instructions from Dr. Lee was to walk and take the stairs slowly, no jumping or stressful exercise. I can resume normal activities however no sauna and swimming to reduce risk of infection. Just to relax and take it slow and easy.

We then went to pay for the bill which was NT$39,714, approximately US$1,323 or CA$1,461. This includes the cost of everything that day (registration fee, Lab fees, ET fee, fee for freezing the 6 extra embryos for 1 year, supplies of Crinone for the next 9 days, blood test on day 27).

We then took a cab home where I rested for the rest of the day. I will return to the hospital for the BHCG blood test next Friday (Sep 19). I am trying to stay neutral but this is all getting very exciting. We are at the end of this first IVF treatment. Implantation is a big mystery. Wondering if I will have one sticky bean there. I try to brush away all negative thoughts. Hubby said I should think positive however I don't want to be positive and to be dealt a hard blow later. Good Lord, I pray for the best!

Day 14, 15 & 16 - Checking the status with the IVF lab at Mackay Memorial Hospital

We were given instructions to call the IVF lab on day 14. When we called, we were informed that 9 out of 9 eggs were fertilized and looks good at the moment. It is very likely that the transfer will be done on the 5th day after egg retrieval (ER) i.e. day 18. If there was any change, we will be informed via phone. However, the next day (day 15) we received a call from the lab to go to the hospital on day 16 to do a 3-day transfer. I became pretty worried that the embryos weren't developing as expected. We showed up at the IVF lab at 9:30 a.m on day 16. As it was a holiday, the lab was closed. We were given instructions to wait outside. We waited for about 5 minutes before an embryologist appeared and informed us that 4 out of the 9 eggs were doing well and the doctor had advised to let them culture for additional 2 days. I asked the embryologist if there is a risk that the embryos will stop developing if we let it grow for another 2 days. She said that is a possibility however given my age and the number of eggs, she doesn't think there should be any issue. I asked her the number of cells of the embryos and she mentioned 7's, 8 & 9. I was relieved to be sent back home as I prefer a single embryo transfer (SET) to a double embryo transfer (DET). I spent the rest of the day catching up on sleep as I wasn't really able to sleep the night before.

Day 13 - Egg Retrieval (ER)

The ER was scheduled for 8:00 a.m. and I had to arrive at 7:30 a.m. My mother-in-law accompanied me to the hospital. We took the subway (MRT) there. My husband was to arrive later at the 6F IVF lab to deliver the specimen at exactly 8:30 a.m. The operation rooms are on the 7th Floor. I arrived on time at the reception and as soon as the paperwork was completed, I was whisked in to change into the hospital gowns and I was assigned a locker number to stow away my stuffs. After changing, I waited for around 5-8 minutes before a lady appeared and guided me to the operation room. In the operation room, they prepared me and asked few questions, mainly the time of my trigger shots, if I had any allergies to anesthesia, if this was my first ER procedure, when was the last time I had an operation. A nurse also inserted an IV into my hand and it was pretty painful initially but the pain subsided after a while. I never saw Dr. Lee come into the room because I passed out before he came in.

When I woke up, my lower right abdomen was in pain however ignoring the pain, I asked the nurse who was wheeling me out to the recovery area the number eggs retrieved. She said 9 eggs in total retrieved. I was expecting 8 eggs!! Now where did that bonus egg come from?! Anyway, I was pretty happy. After a few minutes, I told her that my right side is hurting and she had to call the doctor. As per the nurse, there was another ER procedure being done and it will take a while for the doctor to come and she cannot give me any pain medication unless the doctor advises. Alright, by the time a doctor arrived after an hour, my pain had subsided so I told him I didn't require any pain meds. I don't recognize this doctor but he told me that there were more eggs retrieved from my right ovary hence more pain there.

I rested there for around 2 hours as the anesthesia wore off. My husband and mom-in-law waiting for me outside was wondering what was going on and paged the nurse desk for me. The nurse asked if I felt good enough to leave and I said I was fine. After that my husband came in and escorted me out. While I was in the operation room, my husband had delivered his specimen, paid the bill and picked up the medications. We had to take the medications to the IVF lab on the 6F where the doctor's assistant gave us instructions on taking the meds and application of Crinone. I also had to make a stop at the injection room to inject 2 vials PIO (progesterone in oil) as Crinone could not be used immediately that day. I was expecting the PIO to hurt as much as Menopur but surprisingly it didn't hurt one bit =)

Oh I forget to mention that while I was in the recovery room, Dr. Lee had spoken with my husband and mom-in-law and advised that 9 eggs were retrieved. He mentioned again about the possibility of a 3-day and 5-day embryo transfer (ET).

After that we caught a taxi home and I went to sleep immediately. My lower abdomen was rather achy the rest of the day so I just rested and rested.

The bill for this visit was NT$30,046 which is equivalent to US$1,005 or CA$1,094. This included the fee for registration, surgery, 2 vials of PIO, 10 sticks of Crinone, anesthesia etc.

We are to call the IVF lab on day 14 to check on the number of fertilized eggs.

Day 11 - Ultrasound and Consult

In the morning, my mom-in-law helped administer my Ganirelix shot at home. After lunch, we went to take the ultrasound at 2:00 p.m. then consulted Dr. Lee. It all went pretty fast. I have 8 follicles now and Dr. Lee confirmed the trigger (2 vials of Ovidrel) will be tonight at 10:00 p.m. and ER (egg retrieval) at 8:00 a.m. on day 13. Dr. Lee thinks the number of follicles is satisfactory. He mentioned that he didn't want to overstimulate as the patient will be in discomfort if there are more than 10 follicles. Honestly, I didn't feel bloated or have any other side effects due to the stims.

He also said that if the embryo is of good quality and developing very well, then they may let it develop to day 5 blastocyst stage for ET and he will only transfer one embryo otherwise he will opt to transfer 2 embryo at day 3. Hence right now, the tentative ET days are either cycle day 16 or day 18. I was then given some forms to sign and had to go pay the bill, take my blood test (E2 and progesterone) and meet the anesthesiologist to do the evaluation. The good news is that I will not have to take PIO (Progesterone in Oil) shots. The nurse mentioned that the PIO has been replaced by Crinone which is just as effective. The IVF lab will provide further instructions on this after ER. On the way out we picked up the trigger shots from the injection pick up counter and went home.

That night I didn't have to go to the hospital for the trigger shots as my mom-in-law helped with that and it didn't hurt one bit. I am getting a bit tired of the shots and was very happy that it is the last of them. Now I'm just waiting for the ovum pick up on day 13. I'm praying for the best.

The bill for this visit was NT$3,112 which is approximately US$104 or CA$113, inclusive of the fee for registration, consult, triggers shots and blood tests.

Day 9 - Ultrasound and Consult

Day 9 ultrasound revealed only 7 follicles only however all of them were greater than 1 cm. There is one particular follicle that was running way ahead of the group at 1.93 cm. Dr. Lee said that this bigger one may have to be forsaken as it may be too old at the time of OPU and we need to harvest the other 6 that are growing at the same pace. He gave instructions on the medications to inject for the next few days. There is a change in the medications this time. Below are the details:

Day 9 - 75 IU Gonal-F, 2 vials of 75 IU Menopur and 1 vial of 0.25 mg Ganirelix
Day 10 - 2 vials of 75 IU Menopur and 1 vial of 0.25 mg Ganirelix
Day 11 - Ultrasound and tentative trigger shot at 10:00 pm (1 vial of Ovidrel)

Dr. Lee set the tentative Ovum Pick Up (OPU) to Day 13 at 8:00 am. This largely depends on the results of my Day 11 ultrasound. He has not yet ordered any E2 blood test. As Ganirelix need to be administered before 12 pm everyday and we decided to have both Ganirelix and Menopur administered by the nurse at the injection room at Mackay Memorial Hospital.

The bill for this visit is NT$9,729 which is approximately US$326 or CA$354. This amount is all inclusive as indicated in my older posts. We paid the bill and picked up the medications from the injection counter. We then followed the blue line on the floor which led us straight to the injection room. We then drew a number from the machine and waited for our turn. When my turn came, I handed the medications to the nurse. She injected Ganirelix first which was easy breezy then came the Menopur injection. Woahh...!! Menopur SUCKS BIG TIME.......!!! It BURNS...!!! My hats off to all the ladies out there that are taking the Menopur shot everyday for their IVF cycle! I am super dreading the Menopur shot tomorrow! :(

I am also getting anxious that only 7 follicles after 8 days of stims and my mind was starting to fill with all negative thoughts. My hubby and MIL comforted me that I only need one. I feel better that they are so positive and supportive. It is interesting to note that Dr. Lee still thinks we are on track. I am hoping for the best and expecting the worst at this point.

Bring on the Menopur tomorrow...!!!

Getting around Taipei, Mackay Memorial Hospital - IMSC and Injection room

For the folks interested in IVF at Mackay Memorial Hospital, this blog http://infertilitynotes.blogspot.tw/ provides more details on accommodation, getting around Taipei and general information about the hospital. However please note that this blog was written 2 years ago, as such the contact person of IMSC at Mackay has changed. Below are the contact details.

Annie Hsu
International Medical Service Center
Mackay Memorial Hospital
Tel: 886-2-2543-3535 extension 3372
Email: mmhimsc@mmh.org.tw

Also note the injection room has different operational procedures now. You do not have to line up your injections as per the blog. Instead, the procedure now is to draw a number from the machine and wait for your number to be displayed on the screen outside. To get to the injection room, simply follow the blue line (on the floor) starting from the injection pick-up counter.